The Deep Footprint of Health Care

Calculating the carbon footprint of everything from U2 world tours to pet dogs and cats to presidential inaugurations has become a favorite pastime of the media, a measuring stick by which to label an entity’s environmental damage. But somehow in all of the footprint calculations, everyone forgot to run the greenhouse gas numbers on one of the biggest pieces of the American economy: health care. The U.S. health care sector, from hospitals to nursing homes to doctor’s and dentist’s clinics to pharmaceutical companies and insurance, makes up 16 percent of the country’s gross domestic product. And while many hospitals have launched efforts to help decrease their waste and energy appetites, nobody had taken the time to calculate the industry’s total carbon toll.

That is, until today, when University of Chicago researchers Jeanette Chung and David Meltzer published a letter in the Journal of the American Medical Association that measures the health care sector’s carbon footprint. By running the economic data about how health care spends its resources through a model, created at Carnegie-Mellon University’s Green Design Institute, that estimates the emissions of various greenhouse gases. Chung said she was surprised that nobody had run these numbers on health care effect, but thought it might have to do with the other priorities of the industry of late.

“In this country, the primary focus is on issues surrounding patient safety, health care quality, and cost containment at this current point in time. The health care sector, in general, may be a bit slower than other sectors to put this on their radar screen,” said Chung, a Research Associate in the Section of Hospital Medicine. “But given the focus on health care policy and environmental policy, it might be interesting – if not wise – to start accounting for environmental externalities in health care.”

In Chung and Meltzer’s analysis, health care accounted for 8% of the country’s total emission of carbon dioxide, methane, nitrous oxide and chlorofluorocarbons. That sounds pretty good – health care’s slice of the carbon pie only half the size of its slice of the economic pie – but Chung and Meltzer emphasize that such a huge contribution makes health care a ripe target for environmental improvement.

“If one sector is very large, even if it’s somewhat less carbon-intensive than others, simply the fact that it’s large means it’s a big target, and that’s the case with health care,” said Meltzer, Chief of the Section of Hospital Medicine, Associate Professor in the Department of Medicine, the Harris School of Public Policy and the Department of Economics.

“Obviously, health care and health is very highly valued; you’re not going to shut down a hospital because of its environmental impact or not produce a drug that you think is going to save lives because of carbon output,” Meltzer said. “But this reminds people in health care that we’re not a trivial part of the issue.”

Fortunately, the University of Chicago Medical Center has already been walking the walk on minding our effects on the Earth. Under the umbrella of the University’s Sustainability program, the Medical Center has put a number of programs in place to try and conserve waste and resources. Some of these efforts are as high-tech as the scientific research it supports – the diagram on top of this post isn’t from an immunology paper, it’s a diagram of the new microfiber mops the Medical Center uses to soak up pollen, viruses and bacteria.

Mark Lestina, the Sustainability Manager at the Medical Center, said that hospitals are a challenging place for conservation efforts do their unusual demands and schedules.

“Hospitals are very unique in the way they operate,” Lestina said. “We’re a 24/7 operation, so we need to keep our lights on all the time, our spaces cooled and heated all the time. We operate somewhat like a hotel in a way: people stay here, and we continuously use resources to make them comfortable.”

But Lestina, who first advised the Medical Center as a consultant in 2005 before being hired full-time in 2007, still found places to cut waste…and costs. When he first arrived, the Medical Center only recycled about 5% of its waste – it now recycles 26% percent. In the operating room alone, where sterile procedure tends to generate a ton of trash, Lestina helped institute a plastic recycling program that diverts more than 500 pounds of waste from landfills each day. And helpfully, all of this saves money – the monthly waste bill has dropped from $55,000 to $35,000 at the Medical Center, Lestina said.

“Sustainability does not necessarily just equal garbage and minimization,” Lestina said. “You’re incorporating energy efficiencies, saving water, using less, re-using more and so on, and it almost always leads to lower costs.”